CH5: INFECTIONS Flashcards
Antibiotics that are contraindications to children?
Tetracycline CI < 12 years and breastfeeding
- Bind to teeth and bones
- Hepatotoxicity
Quinolones contraindicated = Risk of joint pain
antibiotics that are contraindications for pregnant women?
- Tetracycline = Hepatotoxic
- Aminoglycosides (1st/ 2nd T)
- Metronidazole (high dose)
- Clarithromycin
- Chloramphenicol = Grey baby syndrome at 3rd T
- Trimethoprim
- Nitrofurantoin at term (28-40 w)
- Quinolones
- Sulphonamides
- Glycopeptides: unless benefit > risks
name the antibiotics that are safe to use in pregnancy
- penicillin’s
- cephalosporins
state the antibiotics that have increased risk of C.diff
- Clindamycin
- Cephalosporins
- Ciprofloxacin
- Co-amoxiclav
state the antibiotics that can cause renal impairment
NAG TT
- Aminoglycoside/ glycopeptides = risk of nephrotoxicity/ ototoxicity
- Nitrofurantoin avoided at eGFR <45ml/min
- Tetracyclines (except doxycycline and minocycline)
- Trimethoprim
state the antibiotics that can cause liver impairment
- Rifampicin
- Tetracyclines
- Metronidazole = dose reduction needed in severe hepatic impairment by 1/3rd of the normal dose.
Name the 1st generation drugs of cephalosporin and what it is used to treat.
PO
‘Fa’ e.g. cefalexin, cefadroxil
Used to Tx: UTI, Sinusitis and otitis media
Cefalexin + Warfarin = increases the risk of bleeding
- mainly gram-positive
Name the 2nd generation drugs of cephalosporin and what it is used to treat.
PO
e.g. cefoxitin, cefuroxime
Used to Tx: UTI, Sinusitis and otitis media
- mainly gram-positive
Name the 3rd generation drugs of cephalosporin and what it is used to treat.
IV
‘one, ime’
Ceftriaxone= meningitis/ gonorrhoea
Ceftazidime = pseudonomas aug. infections
- mainly gram negative
Name the 5th generation drugs of cephalosporin and what it is used to treat.
- Ceftaroline = used in CAP and complicated soft tissue infection
- mainly gram negative
side effects of cephalosporins
- 2nd/ 3rd generations of cephalosporins = can lead to abx associated colitis
- C.diff infection
- Avoid in patients with hypersensitivity to penicillin and other beta-lactams due to cross sensitivity
what type of spectrum is chloramphenicol?
broad spectrum
indication and age used for chloramphenicol?
- Tx: Eye infections such as conjunctivitis
- OTC= 2years +
when to AVOID the use of chloramphenicol?
- pregnancy in 3rd Trimester (28-40 weeks)
- risk of grey baby syndrome
what type of spectrum is clindamycin?
narrow spectrum, gram-positive and anaerobes
indication of clindamycin
- mainly used for skin and soft tissue infections
- LRTIs
- Osteomyelities
- Acne vulgaris
cautions for use of clindamycin
- Can cause abx-associated colitis
- stop in severe/prolonged/bloody diarrhoea
- more common in elderly
- Greater risk of C.diff
- seek specialist advice if can’t be stopped
- Can cause metallic taste if taken orally
contraindications of clindamycin
- Acute porphyria’s: intermittent attacks of abdominal pain and neurological symptoms
- GI disease e.g., colitis
what are the indications of clindamycin
- erythromycin
- CYP enzyme inhibitors - SICKFACES.COM GAVID
what are the indications of clindamycin?
- erythromycin
- CYP enzyme inhibitors - SICKFACES.COM GAVID
what type of spectrum is linezolid?
narrow spectrum, gram positive
safety information of linezolid & monitoring advice
- Risk of severe optic neuropathy
- report a visual disturbance
- monitored regularly if treatment is more than 28 days
- Risk of blood disorders
- Monitor full blood counts weekly
- Monitor regularly if treatment is more than 10-14 days
drug interactions of linezolid
linezolid- is a reversible MAOI inhibitor (avoid antidepressants).
- Tyramine-rich foods: mature cheese, yeast extra, and marmite = can cause hypertensive crisis
- SSRIs, 5-HT1 agonist (triptans), TCAs, Lithium, MAOIs = can cause serotonin syndrome
state the doses differences of macrolides
Clarithromycin (BD)
Azithromycin (OD)
Erythromycin (QDS)
what type of spectrum are macrolides?
Broad spectrum Abx
name the macrolide that is preferred in pregnancy?
erythromycin
what drugs should be cautioned in myasthenia gravis?
MATQ
Macrolides
Aminoglycosides (gentamicin)
Tetracyclines
Quinolones
side effects of macrolides?
- C.diff
- QT prolongation
- Ototoxicity = in large doses
- Hepatotoxicity
- GI disturbances
what are the drug interactions of macrolides?
CYP450 enzyme inhibitor
1. Statins = discontinue use of statins until course of abx is completed = increases risk of myopathy
2. Warfarin = increases risk of bleeding
name the drugs when used with macrolides can cause hypokalemia
- Loop/ thiazide diuretics
- Steroids
- Salbutamol
- Theophylline
name the drugs when used with macrolides can cause QT prolongation
TCAs
SSRIs
Sotalol
Amiodarone
Haloperidol
Antifungals
what type of cover does metronidazole target?
anaerobic cover
what are the side effects of metronidazole
- N/V = to take with or after food to reduce this
- Has a metallic taste
- Brown urine = normal SE
- Furry tongue
- Dry mouth
what can you advise a patient who is wondering if they can have alcohol during the course of their metronidazole treatment?
Avoid = SE disulfiram reaction (N/V, flushing) = hangover effect.
Can have alcohol 48 hours after treatment.
what are the drug interactions of metronidazole?
- Warfarin = increased bleeding risk
- Rifampicin and phenytoin reduce metronidazole concentration
- Lithium toxicity with metronidazole
advise on dosing for a patient with a severe liver impairment who has been prescribed metronidazole?
reduce dose by 1/3 of daily dose and give OD
state the side effects of taking high doses or prolonged doses of metronidazole?
encephalopathy
seizures
peripheral and optic neuropathy
CI: in pregnancy
name the pathogen that causes UTI
E.coli
name the pathogen that causes thrush
Candida Albican
name the pathogen that causes cellulitis
Staph Aures
name the pathogen that causes meningitis
Strep Pneumoniae
name the pathogen that causes CAP
Strep Pneumoniae
name the pathogen that causes CAP
